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Où Est l’Hôpital?

Kathy Wilhelm

I’D JUST ARRIVED IN the charming, car-free village of Murren in the Swiss Alps, and was trying to find my B&B on the helpful signpost near the station. Stepping back for a better view, I tripped over the curb, with my backpack pulling me further off-balance. I went down with my left wrist under my hip.

Two wonderful British couples rushed to my assistance. One pair took my backpack to my B&B and the other escorted me back down the mountain to a doctor’s office. The doctor sent me to the nearest hospital in a taxi, where I was greeted with a request for my insurance card. Since I still sound English, I’m sure the staff expected to see a European Health Insurance Card, or EHIC, which would guarantee that my home country’s health insurance system would pay the bill. Instead, they got the membership card for my ex-employer’s retiree group coverage.

I had broken my wrist badly enough that I needed surgery to insert pins to hold the bones together, after which I spent a night in traction in a six-person ward. Clearly, I wasn’t going to spend the next six weeks traveling solo across Europe. Instead, I’d be going home. Good thing my medical insurance would reimburse me for the hospital bills.

Planning a trip abroad? There are three kinds of insurance to consider.

Cancellation-and-interruption coverage. I rarely buy this. My ramble across Europe was meant to end with a Rick Steves tour of Greece. Fortunately, at the time, the cost of the tour included cancellation coverage, but the terms and conditions have since changed. The company refunded the cost of the tour, except for the deposit, which I was allowed to apply to the same tour the following year. Aside from flights, I was able to cancel my other arrangements without penalty, so I was only out a few hundred dollars.

You can choose to self-insure instead of buying this kind of insurance, which is what I usually do. Still, if your health—or that of a loved one—is precarious, you might want coverage. Keep in mind that most policies require you to make the insurance purchase within a few days of booking the trip if you want pre-existing conditions covered.

Also be sure to read the policy carefully. People have been surprised to discover that pandemics, insurrections, terrorism and wars, among other things, aren’t usually covered. These days, you also need to check the COVID-19 and quarantine provisions. Want a policy that allows “cancel for any reason”? They do exist, but they’re expensive and you still don’t get a 100% refund.

Cancellation-and-interruption policies usually include add-ons like baggage insurance (though lost baggage may also be covered by your homeowner’s or renter’s policy) and coverage for hotel costs if your flight is canceled. Meanwhile, coverage for cancelling a rental car may come with one of your credit cards. Make sure you check your credit card’s provisions for the countries you’re visiting.

I’d consider cancellation insurance if I were taking an expensive tour or cruise, regardless of age or health status. Try comparing policies at InsureMyTrip and SquareMouth. Buying it from the company providing the tour or cruise can be an expensive mistake. Just ask the folks who were planning a trip with Vantage Travel.

Medical insurance. I don’t care how young and healthy you are, accidents happen, as I can attest. If you’re under 65, your U.S. medical insurance may offer coverage abroad. If you’re on Medicare, you’ll only have coverage if you have Medigap plan C, D, F, G, M or N, or a Medicare Advantage plan or an employer-provided retiree plan that includes overseas medical insurance.

Whatever coverage you have, give it a close read. Medigap coverage typically has a lifetime max of $50,000 and a 20% co-pay. As you get older, meaning over age 70 or 75, you may have difficulty getting travel medical insurance, plus it’ll cost more. What if you’re under 70? I’d recommend saving any Medigap insurance for later, and taking out overseas medical insurance while it’s cheaper. Make sure it’s designated as your primary coverage.

Although I’ve seen doctors in the U.K., France and Italy for colds and the flu, an ophthalmologist in Georgia for floaters, and dentists in Poland and China, the visits have either been free or cheap enough that I didn’t bother filing a claim. That’s not what this insurance is for.

Evacuation-and-repatriation coverage. This is what I needed to get back to the U.S. from Switzerland. You have to be careful about terminology. Medical evacuation will get you to the nearest “suitable” facility. Sometimes, it will also get you home—but sometimes it won’t. Meanwhile, sometimes the repatriation coverage will get you home, but sometimes it’ll only get your dead body home. The policy I buy calls the latter “return of mortal remains” and covers it separately.

You may think all this is unnecessary. While I appreciated that my coverage paid for a driver to take me to Geneva airport and for the flights back to the U.S., I could have got myself home, even with a broken wrist. But if I had broken my hip—as happened to a friend in Portugal—or had a heart attack and needed a nurse in attendance, it would have been extremely expensive and more difficult to arrange.

My advice: Don’t skimp on this coverage. It’s one thing to self-insure for cancellation and interruption. It’s quite another to self-insure for medical evacuation. I buy evacuation coverage in combination with medical insurance. Ever since the firm got me home from Switzerland, I’ve bought coverage from Seven Corners, although I haven’t checked its policies lately. If you only need evacuation insurance or you’re on an extended trip, take a look at MedJet Assist.

Some trip cancellation-and-interruption policies also include medical and evacuation coverage, so you can buy all three types of insurance together. I think that cancellation-and-interruption insurance is only necessary in limited circumstances, but I consider medical, evacuation and repatriation coverage nonnegotiable.

Bottom line: Decide what you really need to cover and then read all of the fine print. More than once.

Kathy Wilhelm, who comments on HumbleDollar as mytimetotravel, is a former software engineer. She took early retirement so she could travel extensively. Some of Kathy’s trips are chronicled on her blog. Born and educated in England, she has lived in North Carolina since 1975. Check out Kathy’s previous articles.

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kt2062
1 year ago

Sometimes it’s not even clear from the description what the policy covers. I bought travel insurance that covered cancellation due to illness. Well I was visiting a good friend when a week before my flight to Texas her husband had a massive heart attack. I had to cancel the flight. They said it had to be cancelled two weeks in advance to be covered.

mytimetotravel
1 year ago

I discovered a limit with Medigap coverage I hadn’t been aware of. You will only be covered if the incident/issue starts within the first 60 days you are out of the country. There’s also a $250 deductible.

MarkT29
1 year ago

 Keep in mind that most policies require you to make the insurance purchase within a few days of booking the trip if you want pre-existing conditions covered.

Many policies have a line similar to this in order to get pre-existing conditions covered: “Amount of coverage must be equal to all pre-paid, non-refundable costs.”

tshort
1 year ago

Great post, Kathy. My experience has been very similar to what you shared in every way.

Our first time taking out travel insurance was for a one month roadtrip through southern Germany, Austria, the Dolomites and Slovenia. It was at the tail end of pandemic and there was still testing required to return back to the US, so we decided to play it safe and take out travel insurance in case our trip was delayed due to a positive COVID test – didn’t want to risk losing hotel deposits or pay for changing flights.

As it turned out, the policy we got (through Squaremouth – excellent site) including trip interruption, evacuation, and medical coverages – all of which ended up coming into play when my wife tripped on a slight imperfection in the road surface in a Slovenian parking lot and fell breaking her hip. It was a freakish thing, especially given that we had been literally mountain climbing the day before.

She ended up getting a full hip replacement at an excellent Slovenian hospital, necessitating cancellation of the remaining two weeks of our trip so she could convalesce in Slovenia before flying home.

The insurance we had was awesome – they covered the cost of all our meals, hotels, the one-way drop fee on the rental car due to our new departure point, first-class air tickets for both of us (she had to fly lying flat – doctor’s orders), black car service on both ends – the whole shebang. Amazing.

The insurance also covered the deductible that our regular medical insurance had on it, so we ended up being zero dollars out of pocket. Around $20k total for all of this, for only a couple hundred dollars in travel insurance.

Needless to say, I’m a convert – not tracking any long trips without it ever again.

mytimetotravel
1 year ago
Reply to  tshort

Wow, I’m so sorry that happened to your wife! I hope she has made a full recovery. And congratulations on the great coverage. Do you mind sharing the provider?

DrLefty
1 year ago

Really good information, Kathy. We’ve purchased individual trip coverage (for example when booking a pricey cruise), and I always use my credit card with the best travel protections. But earlier this year, I read an article arguing that you still need a travel policy even with the credit cards, found it convincing, and bought an annual policy that covers all trips in a year for myself and my husband. It was less than $600 for the two of us, and the main peace-of-mind provision is the medical transportation coverage.

I also realized, during our open enrollment period last year, that our health insurance did not cover us abroad, so I upgraded us to a more “Cadillac” plan that does (and once we’re eligible for Medicare, that will help). We made three trips out of the U.S. in less than nine months over the past year, and you just never know.

The one coverage I don’t bother buying is when I book a reservation for our time share properties. If you buy that when you book, you get your points back if something happens—for example, the fire in Lahaina that happened this summer. A lot of people had their vacations canceled at the last minute and were pretty outraged that the timeshare property didn’t make them whole as to their points—but that is exactly what the insurance is for. My feeling is that while I wouldn’t be happy to lose those points, I can afford to lose them, so I’ll take the risk of not buying the insurance.

mytimetotravel
1 year ago
Reply to  DrLefty

“once we’re eligible for Medicare, that will help”

Err, no. As I wrote, Medicare doesn’t cover you abroad (well, aside from three minute, finicky exceptions). Some Medicare Advantage and Medigap plans have some coverage, but it’s minimal. You really need additional coverage – see tshort’s post above.

DrLefty
1 year ago
Reply to  mytimetotravel

Sorry—that was unclear. The “Cadillac” insurance policy we have now through my husband’s former employer is what will cover us abroad. We pay several hundred dollars extra per month now for this coverage, but once we’re eligible for Medicare, it will coordinate with our retiree employer coverage and will cost us little to nothing out of pocket. But we’ll still need the coverage and will likely still buy the annual travel policy as well.

Kevin Knox
1 year ago

Thanks for this typically excellent post.

As frequent international travelers, as well as having lived as expats in Mexico for five years pre-Obamacare, this is terrain my wife and I know well.

In addition to the resources you suggested, I recommend checking rates with tripinsurancestore.com, and also spending some time on the Geo Blue site if all you’re looking for is medical coverage. Unlike World Nomads and most others Trip Insurance store can get you quotes if you’re over 70.

Using a credit card to pay for your trip that offers substantial medical, baggage, evacuation and other coverage is also important. We’ve found the $95 annual fee for Chase Sapphire to be well worth it not just for these coverages but also, critically, because they give you primary (not secondary like most cards) rental car insurance coverage, as well as not charging any fees on international transactions.

We just returned from 3 weeks in France and the rental insurance coverage alone saved us a couple hundred dollars. Almost everything there is contactless now and we charged 90% of our meals and other expenses using the Chase card stored in Apple Wallet on our phones. You get an alert with each purchase and know the exact amount (converted into dollars) that you’re spending – while accumulating points.

BTW it may also be worth knowing that many car rental agencies won’t rent to you after age 70. I’m 66 and while my reflexes are still good enough to drive a little stick-shift Fiat on narrow French “D” roads filled with French people doing 50-60 MPH I can see that those days are numbered.

Last not least, I severely strained a tendon in our last week there and thanks to my wife’s decent French (you’d be amazed how few people speak English outside of Paris) was able to see a doctor for treatment one day after calling them, in a village of 5000. I paid 25 euros (about $27) for the visit and another $15 for prescriptions for heavy-duty pain meds that’d have cost a couple of hundred in the U.S. without prescription drug coverage. Having had several other up-close-and-personal encounters with local doctors in countries ranging from India to Mexico I heartily second your point that what you need the insurance for is really serious stuff; for routine care you’re almost always going to do much better outside the U.S. – sad to say. And as others have pointed out, when you’re an expat you absolutely must buy the best coverage you can get for return trips to the U.S., as no medical system in the developed world is more potentially hazardous to your wealth.

mytimetotravel
1 year ago
Reply to  Kevin Knox

Thanks for the additional resources! I haven’t rented a car abroad since 2004, thanks to the public transport systems in other countries. I have rented a car and driver in a couple of cheaper countries (India and Romania), and if I think transport will be a real difficulty I occasionally take a tour. However, even Uzbekistan now has high speed rail…

Jerry Granderson
1 year ago

Thanks Kathy, sorry your visit to Murren was not the best as it is a beautiful area that we visited in 2022. I agree the medical evacuation is must-have. Over ten years ago I researched this area and settled on using World Nomads. Their policies at the time were underwritten by Nationwide and their prices were significantly better, typically costing us as a couple a few hundred dollars to cover trips of 30 days. Over the years I filed 3 claims, all paid – lost items, baggage delays and medical fees & medicine. Unfortunately for our trip next year to Sicily they will not insure as we turn 70. They only insure under the age of 70.

mytimetotravel
1 year ago

Thanks Jerry, Murren is on my list of “places I should revisit”. I did get to see the mountains the morning I left. Yes, I have aged out of World Nomads, and probably a bunch of other insurers.

Last edited 1 year ago by mytimetotravel
Janet O'Toole
1 year ago

Thanks for the article, Kathy. As a long time American expat, when visiting the States I purchase as much travel/medical insurance as possible to cover any contingency and hold my breathe the whole time I’m visiting. The rest of the world, not such a problem, but always buy coverage to get me home to Australia, dead or alive!

mytimetotravel
1 year ago
Reply to  Janet O'Toole

I grew up in the UK. I find the US medical “system” quite crazy, and stupendously expensive. I entirely understand your concern.

Michael1
1 year ago

Great article on an important topic. Thanks Kathy.

Something to check in the fine print of medical policies for travel is that while the policy may be good for a year, it may only be good for trips up to a certain period within that year. To my recollection, when I last looked the longest trip length I found covered was 90 days.

Last edited 1 year ago by Michael1
mytimetotravel
1 year ago
Reply to  Michael1

Thanks. Right, Seven Corners would charge more for longer trips, although you can do multiples in a year. And cover a lot less when you’re over 80 – don’t wait to travel! I don’t think Medjet Assist cares about trip length, though?

Nick Politakis
1 year ago

Excellent advice. We only think about insurance when something bad happens.

mytimetotravel
1 year ago
Reply to  Nick Politakis

Thanks. This is one thing we buy in the hope that we won’t use it!

Marjorie Kondrack
1 year ago

If only we were all as judicious, thorough and thoughtful in making insurance choices, as you have been. Great post Kathy.

mytimetotravel
1 year ago

Thanks, Marjorie. I haven’t needed the insurance since the accident in Murren, but I’ve still been glad I have it.

Rick Connor
1 year ago

Kathy, thanks for the great information and useful links. We booked an Adriatic cruise for next September, and I plan to use this info to compare prices and coverage with what the cruise company offers.

mytimetotravel
1 year ago
Reply to  Rick Connor

You’re welcome. Do read the link to the Vantage debacle before even thinking about buying from the cruise company!

Nate Allen
1 year ago

What do these insurances generally cost? (as a percentage of the trip)

I’ve read that the “cancel for any reason” insurance that was mentioned generally costs around 4% to 8% of the trip cost and will reimburse 80% to 90% of the total cost of the trip. (It would be impossible to reimburse 100% due to moral hazard. If anyone would like a more complete definition, Google “moral hazard insurance” or something similar for a better description.)

However, I don’t have a sense for what the other types of insurance may cost. (Also, do medical insurances cost more or less based on age or medical history?)

mytimetotravel
1 year ago
Reply to  Nate Allen

There is no one answer. I recommend using the sites I linked to compare coverage and prices. As I posted, if you want pre-existing conditions covered you usually need to buy shortly after your first payment, likely 14 days.

Age is a big factor for medical coverage, although I’ve never been asked medical questions when buying it. Over 70 and some companies won’t cover you. Over 75 or 80 and even those who will may cap your coverage at $50,000.

It looks like a basic one year policy from Medjet Assist costs $315. Seven Corners will sell me, a 76 year old US resident, a medical and evacuation policy with $50,000 in medical and $250,000 in evacuation coverage for a trip to the UK and Ireland for up to 364 days for $373.63. That covers pre-existing conditions up to $25,000: to double pre-existing coverage and increase evacuation to $500,000 would cost $643.39. YMMV.

William Perry
1 year ago

Great practical advice from your lived experiences. Thank you!

mytimetotravel
1 year ago
Reply to  William Perry

Thanks. Being sick or injured when traveling is a truly miserable experience, even more so if you’re solo, but knowing you have financial protection helps. Also, most of these companies provide a contact who will give you advice and get things organized, which is a huge relief.

Jack Hannam
1 year ago

This is an important topic for those of us who are older but still physically able to travel, and you are correct that younger folks need to consider it also. I’m glad you recovered and didn’t sustain a more serious injury!

mytimetotravel
1 year ago
Reply to  Jack Hannam

Thanks. It took a while, but the wrist works pretty well. Have only been in a few emergency rooms, but this was the only time I was the only patient in one! (I’m sure it would be different in ski season.)

Last edited 1 year ago by mytimetotravel

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